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General NPI Number Information
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NPI Number | 1760834212
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Entity Type | Organization
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Legal Business Name | RAVENNA OPTICAL FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 07/08/2016
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Last Update Date | 07/08/2016
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Provider Practice Location Address
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Address Line | 101 E MAIN ST
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City | RAVENNA
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State | OH
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Zip | 44266-3101
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Country | US
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Telephone | 330-297-1419
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E MAIN ST
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City | RAVENNA
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State | OH
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Zip | 44266-3101
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Country | US
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Telephone | 330-297-1419
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. NATASHA HINDMAN
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Credential | OD
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Telephone | 412-925-8093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT6463
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License Number State | OH
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